Local Unit Code:
Quick Assist Loan Application for Active Duty Sailors and Marines
Active Duty ID and most recent LES are required to apply for this interest-free loan.
All elements of the application process must be completed prior to receiving a QAL.
Branch of Service:
Rate/Rank: Pay Grade:
Date of Birth:
: Local Home Address:
Permanent Home of Record:
Preferred Contact Method: Please check
preferred email and phone above.
Spouse Birth Date:
Loan Information - to be completed by Active Duty service member
Amount Requesting: $
(minimum $100 to maximum $500)
Repay Months: 3
*Allotment must be a minimum of $11.00 per month.
The intended purpose of this loan is for:
BLE (housing, food, utilities, clothing)
Are you pending any type of early discharge/release?
Are you pending, or have you had any disciplinary action in the last 6 months
which resulted in a fine and/or reduction in rank?
Are you under Chapter 7 or Chapter 13 bankruptcy protection?
IMPORTANT: Please advise if you are currently in an “overdraft” status with your bank. The bank may use these funds to recoup their money.
The above information is true and accurate to the best of my knowledge. I am aware of all my financial obligations and I
am able to repay this loan. I understand that monies loaned from the Navy-Marine Corps Relief Society are donated by
my fellow Sailors and Marines.
NMCRS 222 (February 2013)
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